[MUSIC PLAYING] This lesson will cover confirmation of client insurance benefits. The specifics include confirming insurance, eligibility check, problems with non-confirmation of benefits.
Many clients are unaware of their insurance benefits. And you'll need to be as educated as possible on the benefits. It's important to confirm client insurance coverage every so often, as clients do not always remember to inform you that their insurance has changed.
Now even if the client fills out paperwork and provides insurance information, it's important to also make copies of the following-- both sides of the insurance card, the client's driver's license or proof of identity. Note that it is also important to have clients resign paperwork if-- they have been absent from counseling for more than 90 days, they have been discharged in the past, or they have new insurance.
If a case is closed and a client returns, you will need to complete another intake session. Most insurances only allow one 90791, or initial intake session, to be billed per year. It's important to know the above information because the 90791 typically reimburses at a higher rate. It's important to consider an EHR, or Electronic Health Record, that has an eligibility check feature as a part of its services. An eligibility check is an EHR feature that allows you to determine the client's actual benefits.
Eligibility checks typically require-- client name, date of birth, address, insurance ID number, and group number. The information provided from an eligibility check includes-- client dates of coverage and termination, deductible, coinsurance, and copay. When eligibility checks happen, payment can be insured or collected on the spot, making the process of collecting payment easier. Information about the eligibility check also keeps the client from being surprised by the amount owed for services, if there are any.
Just because a client has an insurance card does not mean that they have coverage, which is why it is important to frequently confirm coverage. The risk of not confirming coverage can include nonpayment by the insurance company, as well as by the client. It becomes very difficult and costly sending mailings and going through collections agencies to collect payment after a client is discharged or no longer seeking counseling services.
If a counselor sees a client several times before realizing there is a nonpayment, the client could already owe $700, for example, and may not be equipped to pay that. If a client owes money and cannot pay, this leaves you with the choice of sending the client to collections or having to write-off the debt. Note that either solution results in less or no money for services rendered. Keep in mind that 5% of cases consume 80% of counselors' work.
Here's what we covered in this lesson-- first, confirming insurance; eligibility check; problems with non-confirmation of benefits.
[MUSIC PLAYING]
(00:00-00:19) Introduction
(00:20-01:28) Confirming Insurance
(01:29-02:25) Eligibility Check
(02:26-03:28) Problems with Non-Confirmation of Benefits
(03:29-03:42) Summary